tbuckley/cabot-search huggingface dataset:
H01 Chloracne: historical perspectives on an occupational disease, often the result of notorious environmental poisoning
Authors: Alice Manley, Sofia Labbouz, David Gawkrodger
Journal: British Journal of Dermatology (2023)

Abstract First described by the Heidelberg dermatologist Siegfried Bettman in 1897 as an occupational disease in chemical workers cleaning out towers filled with hydrochloric acid, chloracne—not a true acne, despite showing comedones, cysts and pustules, but the manifestation of systemic poisoning by halogenated aromatic compounds—has been the subject of several controversial environmental disasters for over a century (www.biusante.parisdescartes.fr/sfhd/wp-ontent/uploads/2021/05/chloracne.pdf). These disasters include the 1949 Monsanto plant explosion at Nitro, West Virginia, with 226 affected; the 1976 Seveso disaster, which released tetrachlorodibenzo-p-dioxin (TCDD) over a civilian population of around 100 000 (193 definite cases); and mass poisoning by cooking oils contaminated with polychlorinated biphenyls in Kyushu, Japan, in 1968 (&amp;gt; 2000 affected) and Taiwan in 1979 (&amp;gt; 2000 poisoned). Cases have even occurred in England. An explosion at the Coalite and Chemical Products Company works at Bolsover in 1968 released dioxin, leading to 79 cases of chloracne (https://api.parliament.uk/historic-hansard/lords/1980/mar/14/dioxin-escape-at-bolsover-april-1968). An outbreak in 1992 affected 17 workers in North Derbyshire at a plant manufacturing the herbicide dichloroaniline. Another incident occurred in 1997, when seven pharmaceutical chemists who manufactured triazoloquinoxalines, not previously known to be chloracnegenic but 100 times more powerful than dioxins, were affected. Perhaps the most notorious chloracne poisoning, with TCDD, was that of the Ukrainian president Viktor Yushchenko in 2004. Unless exposure is overwhelming, as it was in Seveso, chloracne takes a few weeks to manifest, and systemic changes can be found in the blood count and liver functions tests. Resolution typically takes about 3 years, although skin changes can be permanent. Dermatologists should be vigilant for new cases, especially at the time of industrial accidents, as the chloracnegenic potential of new chemicals is not always apparent.
PS02 Illicit drug use in psoriasis and psoriatic arthritis and its relationship with suicidality in a tertiary population
Authors: Georgia Lada, Hector Chinoy, Peter S Talbot, Richard B Warren, C Elise Kleyn
Journal: British Journal of Dermatology (2023)

Abstract Limited evidence suggests an increased lifetime prevalence of illicit drug use in psoriasis. To our knowledge, there are no data for psoriatic arthritis (PsA) in this regard. Given the pronounced psychiatric morbidity in psoriasis and PsA, including evidence of increased suicidality outcomes, we aimed to investigate illicit drug use prevalence and its relationship with disease characteristics and psychopathology in psoriasis. We surveyed 216 adults attending a specialist psoriasis service, 83 of whom had comorbid PsA. Participants completed paper questionnaires about the type, amount and frequency of lifetime and current illicit drug use (including cannabis, opioids, cocaine/stimulants, hallucinogens and volatile solvents). Participants also completed validated psychometric tools; suicidality was measured with the Sheehan Suicidality Tracking Scale. The prevalence of lifetime (21.7%) and current (6.0%) illicit drug use in PsA did not differ from the respective rates in psoriasis only (27.1% and 8.3%; P &amp;gt; 0.1), but patients with PsA showed lower regular use rates (2.7% in PsA vs. 12.9% in psoriasis only; P = 0.03). Dermatology Life Quality Index and Psoriasis Area and Severity Index scores were numerically higher among illicit drug users than nonusers, but the differences were not statistically significant. In our sample, lifetime illicit drug use was associated with increased lifetime suicidal planning and behaviour but not suicidal ideation. The association of drug use with suicidal planning remained after adjusting for age, sex, psychiatric comorbidity and alcohol consumption scores (odds ratio 2.44, 95% confidence interval 1.04–5.76). Patients reporting current drug use were more likely to have been previously diagnosed with anxiety but were not disproportionately affected by depression and alexithymia. The prevalence of lifetime illicit drug use in our study is consistent with findings from a recent North American psoriasis cohort. Although it is not clear why regular drug use is less prevalent in patients with PsA, increased medical attention may play a role. The higher prevalence of suicidal planning/behaviours, but not ideation, among patients with psoriasis with illicit drug use is an important and concerning finding. This aligns with some previous research suggesting that illicit drug use is associated with suicidality progression toward action, possibly due to impulse-control deficits. Early detection and management of drug use may help prevent suicidal behaviours in psoriasis. Study limitations include the cross-sectional design and social desirability bias-related under-reporting. Prospective cohorts are needed to further investigate the role of illicit drug use in patients’ psychiatric morbidity and quality of life, and address its sequelae within dermatology settings.
P48 Clinical update: ivermectin access for scabies improved through the pharmaceutical benefits scheme change in Australia
Authors: Victoria Cox, Michelle Dowden, Mike Stephens, Bart Currie
Journal: British Journal of Dermatology (2023)

Abstract Scabies is estimated to affect 455 million people worldwide and is a neglected tropical disease that is endemic in northern Australia. Indigenous communities in northern Australia are reported to have some of the highest rates of scabies in the Pacific, with recent prevalence reported to be as high as 25%, with secondary complications including rheumatic heart disease and poststreptococcal glomerulonephritis. However, the high burden of skin disease is still under-reported and under-represented on the national policy agenda. It is essential to consider public health strategies and therapeutic opportunities to address the high burden of disease and minimize serious secondary complications that contribute to the health and life expectancy gap that exists between aboriginal and Torres Strait Islander people and other Australians. Considering the clinical need of the patient population, the management of scabies in northern Australia highlights the impracticality and tolerability issues experienced, with topical permethrin 5% cream as the sole first-line treatment option and use of ivermectin only as a second-line treatment after treatment failure with permethrin cream. This is especially important as poor medication access and treatment failure are well known to perpetuate a cycle of health inequity in northern Australia. A multistakeholder submission to the Pharmaceutical Benefits Advisory Committee was developed to support a change to the listing of ivermectin on the Pharmaceutical Benefits Scheme (PBS) in Australia, and to recommend ivermectin as a first-line treatment option for the management of scabies in aboriginal and Torres Strait Islander people in Australia. The PBS listing was successfully changed after 9 months of review, and from 1 April 2022, oral ivermectin has been listed as a first-line treatment for the management of scabies in aboriginal and Torres Strait Islander people in Australia. It is anticipated that the change in national prescribing will have a large impact on a small number of Australians who face significant disadvantages and health inequity and will improve access of treatment to manage effectively a condition that disproportionately affects First Nations people in Australia. The successful PBS listing change occurred ahead of the release of the new edition of the Australian clinical guidelines, which at the time of writing are scheduled to be released in early 2023. The updated guidelines will include ivermectin as a co-first-line treatment alongside topical permethrin 5% cream for the management of scabies, in addition to considering an ivermectin-based mass-drug administration programme for endemic regions in which the burden of scabies is estimated to be &amp;gt; 10%, as recommended by the World Health Organization.
GD07 The role of the dermatologist in the fight against female genital mutilation
Authors: Stephanie Adeyemi
Journal: British Journal of Dermatology (2023)

Abstract Female genital mutilation (FGM) is a practice that the World Health Organization (WHO) estimates to affect 200 million women globally. The practice of FGM is often attributed to the Middle East, sub-Saharan Africa, North Africa and, to a lesser extent, Asia; however, it is now being witnessed in cities worldwide with high numbers of FGM-practising communities. The WHO defines FGM as ‘all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reason’. While FGM has no health benefits, in certain cultures, the practice confers upon women full social acceptability and integration into the community and serves as a rite of passage to womanhood and marriage (Mpinga EK, Marcias A, Hasselgard-Rowe J et al. Female genital mutilation: a systematic review of research on its economic and social impacts across four decades. Glob Health Action 2016; 4:9). This systematic review aimed to assess the dermatological impact of FGM on women and the role dermatologists can play in the fight against the practice. A systematic review was carried out in accordance with the PRISMA guidelines. PubMed (n = 98), Cochrane (n = 1), CINAHL (n = 8) and Embase (n = 38) were searched for articles published between January 1990 and January 2023 with the phrase ‘female genital mutilation and skin or dermatology’. A total of 148 studies were initially identified; following screening, 21 articles were deemed suitable for inclusion and analysed. The literature highlighted that the main dermatological consequences of FGM were severe keloid formation, hypertrophic scars, vitiligo lesions, clitoral neuromas and, most commonly, epidermal inclusion cysts (Dave AJ, Sethi A, Morrone A. Female genital mutilation: what every American dermatologist needs to know. Dermatol Clin 2011; 29:103–9). A study of women in Somalia who had been admitted to the hospital following complications due to FGM noted that 55.1% of women (n = 65/118) had developed epidermal inclusion cysts. The literature suggests women often feel shame approaching clinicians for help; however, without support, these women can experience years of dyspareunia, dysuria, pruritus, pelvic pain and obstetric complications, as well as increased transmission of sexually transmitted infections and HIV following damage to the vaginal epithelium. By analysing the literature, it is clear further research into the dermatological consequences of FGM is necessary so that a conversation can be had about the ways in which dermatologists can effectively support survivors of FGM. It is important that each woman is recognized as an individual with her own story to tell, her own lived experience and her own humanity.
H19 The bronze diabetic
Authors: Orlagh Mulholland, Kevin McKenna
Journal: British Journal of Dermatology (2023)

Abstract Many works of art throughout the centuries have not only garnered intrigue, but also debate among physicians relating to a possible medical diagnosis depicted by the artist. Representation of both anatomy and disease with the use of votive offerings and forms of grotesque art is well recognized. Such work was particularly prevalent in pieces produced during the Hellenistic Age and includes statuettes, anatomical replicas, coins and other art work. Diseases such as acromegaly, Gorlin syndrome, lymphoedema, neurofibromatosis and ophthalmic disorders, among others, have been represented in such pieces. It had been thought by the suppliants that in presenting these offerings to the Gods, particularly Asclepius, the Greek god of medicine and son of Apollo, they could be cured from their ailments. An example of an artistic piece representing an individual with disease is that of a small bronze statuette described as a ‘Statue of an Emaciated Man’ and housed at the Dumbarton Oaks Research Library and Collection, Washington DC. It is a small bronze statue measuring at just 11.5 × 5 × 8.3 cm, and is thought to date from around the first century Bc to the first century Ad. It depicts a gaunt young man sitting atop a bench with his left hand held limply and an apparently swollen right foot. It has been suggested that this individual could have suffered from lead poisoning. However, lead neuropathy is typically symmetrical and emaciation is uncommon. A more common source of lead poisoning in ancient times was wine drinking, as lead was used both as a sweetener and preservative. In addition, occupational exposure was common as lead was used widely in pottery, painting, lead smelting and glass ceramics. A disease that could explain the three features of emaciation, wrist drop and a swollen foot is diabetes mellitus. Diabetes had been recognized in Egyptian manuscripts dating back to 1500 Bc commenting on ‘honey urine’. Diabetes has been well documented during the Hellenistic Age with Apollonius of Memphis in 250 Bc being credited for coining the term ‘diabetes’. Insulin insufficiency can cause emaciation mainly through ketosis. The neuropathy of diabetes mellitus can affect single nerves, and a radial nerve palsy resulting in a wrist drop has been recognized. The appearance of an apparent swollen foot could be due to a Charcot joint, which is a result of repetitive microtrauma-induced complications of polyneuropathy. In conclusion, we believe this statuette represents features consistent with diabetes mellitus and is a ‘bronze diabetic’.
CD04 An unusual case of menorrhagia and an episodic rash
Authors: Faheem Latheef
Journal: British Journal of Dermatology (2023)

Abstract A 24-year-old female university student from Hong Kong was referred with a 4-month history of a vesicular rash on her lips, eyes and oral mucosa that always appeared around the same time of her menstrual cycle. She would also get similar lesions on her neck, arms and legs. She was seen in dermatology and given a provisional diagnosis of erythema multiforme/recurrent herpes simplex and started on treatment, as well as prophylactic dose aciclovir for a few months. Despite this, there was no improvement in symptoms and her viral swabs also came back negative. She was referred for a second opinion, and, on reviewing her history, she volunteered that she suffers from menorrhagia. On questioning regarding any use of painkillers, she took out a packet of 60-mg etoricoxib that she had been getting from Hong Kong over the counter (OTC) and which was not on her records in the UK. She was taking this on day 1 of her period, and the vesicular eruption appeared the following day; it also became apparent that it would occur at the same sites on her body each time. A fixed drug eruption (FDE) to etoricoxib was suspected, and patch testing was undertaken to our baseline, facial and photopatch series (which includes a number of nonsteroidal anti-inflammatory drugs), to the medication crushed in paraffin applied to the back as standard and also to the specific sites at which the eruptions occur on the neck, arms and legs (lesional skin) under occlusion. No reactions were seen at 48 h, but at 72 h, we noted vesicular eruptions morphologically identical to the very dramatic photos she had on her phone but only in the areas where she had previously reacted (lesional skin); no reaction was seen on the nonlesional skin on the back where the standard patch testing was performed. Her rash fully resolved after stopping the etoricoxib. This case highlights the importance of enquiring about OTC medications when seeing patients with unusual or recalcitrant presentations as the flare with the menstrual cycle was a red herring and also highlights the importance of patch testing lesional skin with the culprit medication to avoid false negatives when considering FDE. This is a rare presentation of a FDE to etoricoxib, with only eight other cases reported in the literature, but this should be considered as a differential diagnosis in someone presenting with an erythema multiforme-like eruption.
BT01 Taking pressure off the skin cancer service: impact of primary care dermoscopy pilot, medical photographer-led clinics and non-2-week-wait skin lesion advice and guidance pathway
Authors: Iman Darwish, Daisy Sandhu, Kapila Batta, Caroline Champagne
Journal: British Journal of Dermatology (2023)

Abstract Since the COVID-19 pandemic, we have struggled with similar pressures and capacity issues as most dermatology departments across the country. Our number of 2-week-wait (2WW) and general referrals have increased by 26%. To manage this, we have gradually introduced strategies based around a triaging system for 2WW referrals received with photographic images from the general practitioner (GP) via the National Health Service e-Referral Service (e-RS). We triage patients either to a face-to-face 2WW clinic, a spot clinic run by supervised junior members of the team or a photography/dermoscopy clinic. If we receive dermoscopic images with the GP referral, where appropriate, we can discharge or downgrade the patient to a routine clinic. Strategy 1: in September 2021, we set up a 1-year primary care 2WW dermoscopy pilot. Dermatoscopes were delivered to interested GP practices (appropriate technical training was provided), and the GPs attended skin lesion teaching sessions every 2 months. Thirteen per cent of all our 2WW referrals came through this dedicated pilot 2WW e-RS pathway. We discharged or downgraded 26% of those that were referred with both macroscopic and dermoscopic images. All GP practices (not just the pilot practices) in our region now have dermatoscopes. Strategy 2: in July 2022, we introduced secondary care photography/dermoscopy clinics run by both dermatology nurses and medical photographers using the Pathpoint/eDERMA platform. We triage patients from 2WW e-RS referrals with macroscopic images suggestive of benign lesions to these clinics. We can discharge or downgrade directly from the platform, which immediately sends patients’ information about their diagnosis and management plan via text message. Around 15% of 2WW referrals are booked to eDERMA clinics and around 60% are discharged. Strategy 3: in October 2022, we developed a non-2WW advice and guidance (A&amp;G) e-RS skin lesion pathway for lesions of diagnostic uncertainty and basal cell carcinomas. Dermatoscopic images are not an essential requirement as this is not a 2WW pathway. Referrals are triaged within 72 h, providing rapid advice to GPs. Initial data show that since introducing this service, 2WW referral numbers decreased by 32%. Of the A&amp;G referrals, 28% were discharged with advice and 17% were upgraded to 2WW. Within 3 months of starting this pathway, our department’s 2WW and Faster Diagnostic Standard 28-day cancer targets were no longer breaching. The combination of GP-based photography and dermoscopy, careful triage to a 2WW photography clinic in secondary care and a non-2WW lesion A&amp;G pathway has significantly improved our 2WW service.
H02 The Foundling-Chapel brawl 1804: Robert and Mary Willan, trial by social media
Authors: Les Millard
Journal: British Journal of Dermatology (2023)

Abstract The social media of the late 18th and early 19th centuries was no less humorous, critical and potentially personally destructive than now, despite its form, distribution and time frame being quantitatively different. Cartoons and prints, broadsheets, leaflets and pamphlets were widely distributed by hand for sale cheaply, being passed on for maximal effect. Gillray, Rowlandson and the Cruikshanks were the masters of these media, but others were prolific and no less accomplished at targeting royalty, religions, politicians and individuals of particular merit, such as physicians. One such satirical caricaturist and pamphleteer was James Sayers (1748–1823), a favourite of Prime Minister William Pitt. In 1804, he wrote a verse satire, attacking Dr Robert Willan (1757–1812) and his wife Mary (1770–1844) after an incident in the Chapel at The Foundling Hospital (Nichols RH, Wray FA. History of the Foundling Hospital. Oxford: Oxford University Press, 1935), where his sister Elizabeth was in dispute with them over the occupancy of a pew (pews were rented by the hospital governors on an annual basis). They were both subjected to a clever—not always subtle—diatribe for some 2 years about their personal and professional integrity, including their religion. Willan was described as a ‘learned leech’, with the implication that this successful physician was not just bleeding patients therapeutically, but also financially. His patients were ‘scabby’ and therefore detestable, and he was a lesser man because he was no longer a Quaker. For Mary, there were intimations about her temperament, her motives for marriage and her personal hygiene. The recently married couple had moved from 14 Bloomsbury Square to nearby number 10, with her two daughters by her previous marriage. There, their son Richard was born in 1802. Robert Willan withdrew from his work at the Carey Street Dispensary in 1803. Re-reading this rare publication by Sayers, which may seem a negative satire, inadvertently provides clues to the personal and social context of the Willan’s early married life.
DP09 The lupus band test: a review of the sensitivity and specificity in the diagnosis of lupus erythematosus
Authors: Sarah Ní Maolcatha, Eilis Nic Dhonncha, Cathal O’Connor, Sinead Dinneen, Cynthia Heffron
Journal: British Journal of Dermatology (2023)

Abstract The lupus band test (LBT) is a direct immunofluorescence (DIF) technique which shows a band of localized immunoglobulins at the dermoepidermal junction in lesional, non-sun-exposed skin of patients with both systemic (SLE) and cutaneous lupus erythematosus and in the perilesional skin of patients with SLE. However, low sensitivity and poor concordance between histological and clinical diagnoses warrant a review of the application of the LBT in the diagnosis of lupus erythematosus (LE). The aim of this study was to assess the sensitivity and specificity of the LBT in diagnosing LE following clinicopathological correlation (CPC). All cases sent to our pathology department between 2011 and 2018 for DIF with a clinical query of LE were reviewed. Data collection included demographic details, pathology requests, histology and DIF reports, clinical reports and diagnoses and serology. Of 256 histology requests, 9.0% (n = 23) had a positive LBT. This was discordant with the prevalence of LE diagnosis, as 46.3% were diagnosed with LE following CPC. The sensitivity and specificity of the LBT for LE were 17.6% and 98.8%, respectively, with a positive predictive value of 92.9% and negative predictive value of 58.2%. The LBT is not a sensitive diagnostic test for LE, but is highly specific and should be considered as a supportive diagnostic tool for LE. This is the largest reported case series to evaluate the efficacy of the LBT in the diagnosis of LE.